bowel routine protocol

[dayshiftnurse]

hi, i know this is a simpler question...but still hoping for some clarification from other nurses.

what is the standard prn protocol steps at your facility (or based on your experience) for steps in the bowel routine. for example if you had a broad order for "loc" ie., laxative of choice, and you could choose from:

100 mg colace (ducosate sodium)

240 mg ducosate calcium (surfak)--usually this is routine/not prn but i just threw it in there

15-30 cc milk of mag

15-30 cc lactulose syrup

2 sennakot tabs

out of these choices, any feedback for the order the laxatives should be given in? (i.e., most mild to strongest medication)--like which one you would start with and then the order you would progress in if patient still had no result.

thank you!

[rnmi2004]

We don't have a standing bowel protocol. We do assess last BM as part of our head-to-toe, and pass that on in report. Many MDs order prn meds for BMs, usually the ones you listed. Other MDs have at least a stool softener or Senokot S ordered routinely on our postop pts, because they are at higher risk of constipation due to pain meds, lack of mobility, etc.

In my experience, this is the order I'd choose, assuming the pt does not have diarrhea or loose stools. It's also a good idea to ask the patient if they've ever used these products & if they have a preference.

Colace (stool softener, not a laxative, BTW)

Senokot

MOM

Lactulose

I'm not familiar with Surfak as it's not one the docs around here use.